Effect of Anemia on Cardiovascular Hemodynamics, Therapeutic Strategy and Clinical Outcomes in Patients With Heart Failure and Hemodynamic Congestion

• Published in: Circulation Journal Vol. 81; no. 11; pp. 1670 - 1677
• Main Authors: Tanimura, Muneyoshi, Dohi, Kaoru, Fujimoto, Naoki, Moriwaki, Keishi, Omori, Taku, Sato, Yuichi, Sugiura, Emiyo, Kumagai, Naoto, Nakamori, Shiro, Kurita, Tairo, Fujii, Eitaro, Yamada, Norikazu, Ito, Masaaki
• Format: Journal Article
• Language: English
• Published: Japan The Japanese Circulation Society 25-10-2017
• Subjects: Aged; Aged, 80 and over; Anemia; Anemia - physiopathology; Arterial Pressure; Cardiac Catheterization; Female; Heart failure; Heart Failure - therapy; Hemodynamics; Hospitalization; Humans; Male; Middle Aged; Pulmonary Wedge Pressure; Treatment Outcome; Ventricular Function, Left; Heart failure; Anemia; Hemodynamics
• ISSN: 1346-9843; 1347-4820
• DOI: 10.1253/circj.CJ-17-0171

Background:We investigated the effect of anemia on cardiovascular hemodynamics, therapeutic strategies and clinical outcomes in heart failure (HF) patients.Methods and Results:We divided 198 consecutive HF patients who underwent right heart catheterization before in-hospital HF treatment into 2 groups according to the presence or absence of hemodynamic congestion (HC: mean pulmonary capillary wedge pressure ≥15 mmHg and/or mean right atrial pressure ≥10 mmHg). The hemoglobin level correlated with the cardiac index (CI) and systemic vascular resistance index (SVRI) (r=−0.34 and 0.42, P<0.05, respectively), and was the strongest contributor of SVRI only in the HC group. Anemic patients more frequently required intravenous inotropic support despite having higher CI and lower SVRI than non-anemic patients in the HC group. The novel hemodynamic subsets based on mean right atrial pressure and estimated left ventricular stroke work index but not Forrester subsets appropriately predicted the need for intravenous inotropic support. The probability of hospitalization for worsening HF during 2-year follow-up period was significantly higher in anemic patients than in non-anemic patients in the HC group.Conclusions:Anemia had a direct effect on cardiovascular hemodynamics and thus can confound therapeutic planning in HF patients with HC. The novel hemodynamic subsets can be applied in daily clinical practice regardless of the presence or absence of anemia.